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Growth of Public Health
The manner in which other injurious physical factors in both the social and working environment
were dealt with in the early practice of public health and preventive medicine readily
come to mind, such as improvement in housing by slum clearance and the planning of redevelopment
schemes and improvement of working conditions in factories. So at present it may
well be that the elimination of harmful agents from the air we breathe could have a similar
beneficial effect in reducing the incidence of lung cancer. Who knows but that the introduction
of smoke-controlled or smoke-free areas under the new powers given to Local Authorities by
the Clean Air Act may reduce considerably this scourge, even before the research workers
have discovered its specific cause?
The evolution of public health measures naturally involves the further encroachment of
central and local government by statutory powers into the realm of freedom of the individual.
This limitation of freedom has been considered equitable in certain instances for the preservation
of the health of the community. In fact, in certain instances this 'police-like' action has
been necessary to save the life of a community when threatened by an epidemic disease with
high mortality such as cholera or smallpox. Drastic measures, even those which we would today
consider barbarous, were taken in certain instances. In this tercentenary year of the great
plague of London one recalls that the Lord Mayor and Magistrates attended to the cleanliness
of the city and the relief of the poor so that there was little or no actual want. But the administrative
measures, carried out with the best intentions to limit the spread of infection, in
fact led to further dissemination of the disease. One house after another was shut up with all
its occupants inside. Thus each became a focus for further spread of disease. This was
followed by the marking of such houses with a red cross and the legend 'God have mercy on us !'
No one would doubt the necessity for governments to have powers such as are given by
the present-day International Sanitary Regulations to control by quarantine the spread to other
countries of diseases such as smallpox, cholera, plague, yellow fever and typhus. Thus it is
that controls which were at first introduced by individual States for self-preservation or
protection have become adopted internationally. This unification of the world by rapid
transport has its dangers and so legislative means to protect nations against the importation
of dangerous epidemic diseases are justifiable.
THE MEDICAL OFFICER OF HEALTH'S RESPONSIBILITIES
The Medical Officer of Health is appointed by a local authority and he is granted certain
statutory powers and given duties to perform. The terms and conditions of his appointment are
even to some extent circumscribed by legal requirements. For example, he enjoys security in
his tenure of office whereby he cannot be dismissed without the concurrence of the designated
central government department and only then after due enquiry. The Public Health Service, in
which the Medical Officer of Health holds a full-time salaried appointment, was the first sector
of the medical profession to come under State authority as a 'servant'. However, subsequent to
1948 with the introduction of the National Health Service, practically all doctors in this country
are engaged in, and receive remuneration to some extent from State appointments. The relationships
of a doctor practising in a State-run Health Service give rise to many specific
responsibilities which he did not previously encounter when he was engaged in private practice.
An attempt will be made to define and illustrate some of these responsibilities in relation to
the work of a Medical Officer of Health.
The duties of a Medical Officer of Health are largely laid down in Acts of Parliament or
subsidiary rules, orders or byelaws and they determine the functions of the employing
authority. So whether it be the abatement of a statutory nuisance, control of an outbreak of
smallpox or the provision of a domiciliary midwife for the home confinement of an expectant
mother, all stem from statutory powers or duties.
The Medical Officer of Health is not solely responsible for environmental health. Every
doctor to some extent is engaged in this work. A practitioner, as he seeks to treat his patients,
may become aware that there are diseases in which the patient's environment constitutes some
specific adverse factor. This factor may be physical, psychological, social or spiritual in
nature. He may discover an allergen in the home environment which is causing his patient's
asthma. The industrial medical officer may find that the worker's dermatitis is due to the
irritant effect of the material he handles in the factory. The psychiatrist may discover that the
underlying complex of an anxiety neurosis consists in his patient's repressed hatred of
someone. How important in our environment are the people whom we meet each day! Maladjustment
in personal relationships has been shown to be one of the main causes of mental illness.
The M.O.H. recommends to the local Health Committee how best to help the people in the
area. These duties extend beyond the elimination of harmful agents from the environment to the
attempt to contribute directly to the health of individuals. An example is the introduction of
various schemes of immunisation against specific infectious diseases such as diphtheria,
poliomyelitis, whooping-cough, tetanus and tuberculosis. These schemes followed compulsory
vaccination against smallpox but were voluntary, both for parents and children. Those immunised
obtain active immunity, and if a sufficient number of the population are protected, the disease
can be eliminated from the community giving protection to all.
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